Healthcare Provider Details

I. General information

NPI: 1992929384
Provider Name (Legal Business Name): OCULOFACIAL ASSOCIATES OF CONNECTICUT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CORPORATE DR SUITE 112
TRUMBULL CT
06611-1376
US

IV. Provider business mailing address

2 CORPORATE DR SUITE 112
TRUMBULL CT
06611-1376
US

V. Phone/Fax

Practice location:
  • Phone: 203-452-9723
  • Fax: 203-452-9724
Mailing address:
  • Phone: 203-452-9723
  • Fax: 203-452-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number022088
License Number StateCT

VIII. Authorized Official

Name: MARK RUCHMAN
Title or Position: OWNER
Credential: M.D.
Phone: 203-452-9723